VA Screwing TBI Vets – Get These Quick Facts For Your TBI Evaluation

From 2007 to 2015, VA consistently used unqualified doctors to perform TBI assessments resulting in many veterans being wrongly denied benefits. This article contains all the inside baseball resources I received from VA through a FOIA request and investigations over the course of a few years leading up to the exposure of the scandal with help from Kare 11 News here in Minneapolis.

VA gives tons of TBI evaluations every day, but before your TBI evaluation, make sure you are armed with the facts.

Today, I put together this down and dirty collection of most of my data from VA regarding its treasure trove of traumatic brain injury (TBI) evaluation materials I received through two FOIA requests I recently received back from the VHA FOIA Office. These evaluations are specifically for Compensation & Pension (C&P) evaluations.

Exposure of the TBI database I assembled below led to the exposure of a massive VA scandal where VA admitted to using unqualified doctors and nurses to evaluate TBI service-connection for veterans from 2007-2015.

Training Videos To Diagnose Mild TBI, Moderate TBI, Severe TBI

The videos below are the actual training videos VA uses to educate its medical staff before they can evaluate you. When you watch the videos, you may notice some unusual things about the way the narrator talks and how often they fail to mention moderate TBI and severe TBI. Moreover, the videos are hard evidence that VA encourages its examiners to attribute the residuals of TBI to post-traumatic stress disorder (PTSD) and related mental health disorders.

It is almost as though VA wants to minimize the residuals of TBI to avoid payment. By attributing symptoms to PTSD instead of TBI, it inhibits a veteran from receiving a rating of 100% Permanent and Total. It does this because PTSD ratings are presumed to improve and result in VA requiring follow up evaluations every few years. Further, it keeps the rating lower due to the combined rating math VA uses. Beyond this, there is a huge stigma about veterans with PTSD, and being inappropriately diagnosed with PTSD could case a very real harm in both society and in the type of health care they receive.

TBI Residuals

Veterans suffering from the residuals of TBI not only have to deal with their own problems, but they have to deal with VA covering up the severity of their injuries.

Why? Because the DoD and VA do not want the American public to truly know the cost of war when the troops come home. If we knew the real cost of war, we would probably change our foreign policy.

I have heard the most absurd denials lately and want to tell you of a few.

Charles Gatlin Case

Most recently, my friends Ariana and Charles Gatlin were put through the ringer. There, a VA psychologist used an improper screening tool, according to the Montana Board of Psychology. Gatlin suffered a TBI in combat when he was hit from with a car bomb while dismounted in Iraq. He had already been diagnosed with moderate TBI three times by DoD doctors. He was then medically retired at 70% for TBI before VA had its way with him and dropped his rating for TBI to 10% for mild TBI three years later.

Another veteran was shot in the head and received a 0% disability rating. Yet another was knocked unconscious for 30 days by an improvised explosive device (IED) and had a Glascow Coma Score of 3 – the score does not go any lower – he has a TBI rating of 10%.

Signs You May Have Been Screwed

TBI Claim Problems

There are some warning flags to help you know if you were screwed with a denial, 0% rating or 10% rating:

If your behavior was altered for some time post TBI, unusual urinating in sleep, sleep walking, etc (possibly moderate TBI)

If you were unconscious for longer than 30 minutes or the amount of time is not truly verifiable, ie you did not have a stop watch running (possibly moderate TBI)

If you have gliosis or some form of brain scarring via an MRI or CT Scan but VA said it was MS or Lymes Disease (possibly moderate TBI)

If you have memory problems, had a positive neuropsychological screening, ie objective evidence, and the doctor blamed it on alcohol (possibly moderate TBI)

If you have a lot of subjective symptoms with only a 0% or 10% rating

[This is just a generalization for informational purposes only. Individual claims may vary.]

Mild TBI vs Moderate TBI

Note that a moderate TBI with residuals could be rated at 70%. Mild TBI with residuals and objective evidence (psych assessment and/or positive imaging) could be rated between 40% to 70%. It is important to note that the initial severity of the injury does not absolutely predict long term prognosis. This means that a patient with a mild TBI may fully resolve with no permanent symptoms. Similarly, a patient with either a mild TBI or moderate TBI may not fully recover and have minimal residuals – such a person could possibly receive a lower rating from VA.

TBI Severity

It is important to note VA’s “level of severity” measure, which could vary depending on the point of view of the medical examiner. A “3” will warrant a 70% rating for TBI plus residuals. For that evaluation level, the examiner must find evidence to support a moderate cognitive impairment in memory, attention, concentration, or executive functions facet.

The catch here is that the symptom in question must be attributed to TBI and not something else. Many moderate impairments types at level 3 are excluded by most examiners if the severity of initial TBI was not greater than mild. As you will notice in the videos, more severe symptoms are assumed to be attributed to other things since mild TBI does not usually last longer than a few months in 95 percent of all TBI victims. So, while VA claims initial severity does not matter for a TBI rating, it actually does by serving as a filter for higher disability ratings.

The fact is, VA is all over the map on TBI, and its policies ignore modern science to save a buck. They use tests that were created to diagnose dementia, and then use those to measure a veteran’s TBI severity and residuals. If you had already been diagnosed with TBI but VA later wanted another bite at the apple, be sure VA used the right examinations and not a mere screening.

Screenings are generally used when there is no confirmed condition. They are less accurate but are quick and cheap to give. Learn more about VA’s screening tools, referred to as Brief Assessment Batteries in this linked VA presentation.

Evidence On TBI Claims Processing

Here is the evidence and how we got it

Back in December, I filed a FOIA request for all VA’s training materials related to TBI and the certification all clinical providers are required to pass prior to doing a C&P evaluation. I filed a second FOIA to see what our local Minneapolis VAMC uses to diagnose and treat TBI. I have put countless hours into this project to poke holes in VA’s fraud against veterans, and that work has finally paid off.

I plan to explore the data more in depth over the coming weeks, but I wanted you to have access to the documents to help with your claims, immediately. VA is trying to scam veterans and their families out of billions in compensation and support by forcing families to bear the cost of the long term conditions.

VA TBI Training Video 1 of 2

Statements in video to take note of in Part 1:

Severity must be assessed in 24 hours and cannot change (incorrect fiction created by VA)

(Yet, only mild TBI can be fully assessed in first 24 hours)

Moderate to severe symptoms cannot be assessed until after day 1

Mild TBI is addressed almost exclusively, few notes on symptoms of moderate TBI and severe TBI

Notice “malingering” and veteran knowledge of condition

This video mentions mild TBI almost exclusively. The statement that TBI severity must be calculated within the first 24 hours and that it cannot change from that point is absurd. Such a scheme could cause a veteran to be improperly noted to have mild TBI because only the first 24 hours matter (according to VA). Then other residual conditions could be falsely attributed to PTSD and other disorders. However, in order to comply with VA regulations, any evaluation must factor in the full week after the injury to see if additional impacts are noted.

By failing to equally address symptomology from A to Z for each severity level (mild, moderate, severe), it gives examiners a false emphasis of potentially less severe symptoms. They will not be familiar with symptoms that fall into the grey area.

This is similar to the Madigan scandal and earlier Army scandal where veterans were falsely diagnosed with Personality Disorders to avoid payout for TBI and PTSD.

VA TBI Training Video 2 of 2

Statements to take note of in Part 2

Symptoms Of TBI

Immediately within the first minute, you should notice something about screening accuracy. These screenings like MoCA do not catch all the symptoms of TBI. Yet, if the veteran’s particular symptoms are not addressed in the pre-existing exam, that veteran would have a reasonable chance of being improperly denied benefits.

Here, the psychologist is a fellow and not a full-time neuropsychologist at the facility. I think his lack of training and experience is worth noting.

Montreal Cognitive Assessment

He does not identify MoCA by its full name, the Montreal Cognitive Assessment. He also fails to adequately address that MoCA was created to screen for dementia in Alzheimer’s patients. The screening tool is for use to detect “mild cognitive impairment” and not moderate TBI or severe TBI related to measures of cognitive impairment. Moderate TBI and severe TBI symptoms can be far more complicated and may not show up in a MoCA screening.

False Positives vs False Negatives

Also, you should notice he talks a little about false positives but does not dig too deep into false negatives. A false positive happens when you flag someone as having TBI symptoms when they do not. He also claims that symptoms will not “wax and wane” and that test results should not be terribly different across a span of time. Of course, if you have a bad “fatigue” day or excessive stress that day, your results will likely be significantly different than on a good day.

“Average” vs The Veteran

Another factor that strikes me as odd is VA’s fixation on “average.”

If you score average on the screening, they immediately conclude you are fine and that no TBI with residuals exists. This puts many “high functioning” individuals at a disadvantage because, overall, they will have good scores despite some severe deficits due to TBI. VA will punt these people, meaning they will deny their claim or minimize it.

However, like a sports car, if one component in the car is off, the entire car might run horribly. Yet, if you check each part individually, you may not notice the problem. Thus, it is possible for a Jaguar to run more slowly than a Ford Escort if one of its 12 cylinders is misfiring.

Segmentation Of Disability vs Entire System

That is VA’s entire strategy when it comes to C&P based on my own research. They segment each condition and body part away from the whole, which could minimize the overall impact of the condition. Whether accidental or overt, this strategy is harming veterans. We not only fail to get proper compensation, we also have certain medical benefits withheld since the condition was missed by C&P.

Getting an initial TBI determination from VHA on the health care side can be like pulling teeth. Yet, if you have a TBI determination from C&P, the gates open up and you can generally get in quite quickly to your local TBI specialty clinic if your VHA has one.

Feedback On TBI Claims

If any of you have feedback or additional information, please send me a note. This topic is huge, almost as big as the fraud VA is pulling over the eyes of the American public.

ABOUT FOUNDER
Benjamin Krause is a lawyer, investigative reporter and award-winning veterans advocate. He is author of the guide Voc Rehab Survival Guide for Veterans and chief editor of DisabledVeterans.org.
He received his Bachelors from Northwestern University and Law Degree from the University of Minnesota, both using VA Vocational Rehabilitation and Employment.
He is also featured regularly in national publications as an authority on Department of Veterans Affairs policy such as Bloomberg News, Foreign Policy Magazine, Washington Times, Fox News, CBS, NBC, Star Tribune and more.
_____________________________________________________________

73 COMMENTS

IF I COMMIT A CRIME OVER AND OVER AND OVER……OVER, DO I GET 10-99 % OF THE PUNISHMENT ? THE GOVT/VA IS NO DIFFERENT. TYHEY HAVE DAMAGED AN INNUMERABLE NUMBER OF VETS, YET THEY GET AWAY WITH THIS “RATING GAME”. YOU BROKE IT, YOU BOUGHT IT.
THE MAJORITY OF THOSE WHO NEED HELP AREN’T EVEN AWARE SOMETHING IS WRONG. WE ARE NOT “DOCTORS”, AND WHEN WE TRY TO EXPLAIN OUR MALADIES, THE VA PLACES THE BLAME ON US, WITH THEIR “RATINGS” AND DENIALS. IF WE WERE SO “DAMAGED OR UNFIT” AS WE HAVE BECOME, WHY MAKE US SERVE ? WHAT WERE ALL THOSE “PRE-BASIC” TESTS/PAPERWORK USED TO DETERMINE. THERE IS NO PRICE TAG ON A “LIFE INTERRUPTED”, BUT ACCORDING TO THE GOVT/VA YOU CAN RATE YOUR RESPONSIBILITY. SURE WISH WE AS “CITIZENS”(THEIR BOSSES) HAD THE SAME PRIVILEGE WHEN IT CAME TO OUR “MISTAKES”.
MAY OUR HEAVENLY FATHER BLESS/KEEP US ALL THROUGH THESE TOUGH YEARS, UNTIL WE CAN ALL BE ONE, AS HE SEES US.

These majority of these people are morally corrupt. You are absolutely right that with god we will find peace and happiness, while these evil people will not. They will eventually pay but it is not for us to decide they will be judged by god. Keep fighting for your rights, keep asking questions, be careful around these people and do not trust them. You have a right to feel what you are feeling. Take care.

I would like to ask a question I had an C&P for TBI I had 2 for Memory attention 1 for judgement,1 for Social interaction, 2 for Orientation, 1 for visual spatial orientation, 1 for Subjective symptoms and 1 for Communication. I am confused because if you get for 1 facet a 2 that means the rating 40 but how are the rest facets rated?

Great post, Ben. When I served in Vietnam, neither PTSD or traumatic brain injury due to concussion had yet been named, studied or admitted to by VA. I wonder how many Vietnam vets had their lives unknowingly negatively impacted by TBI? I know this, I served in an artillery battery of 8″ and 175 mm artillery pieces which fired around the clock. We had two of each in our battery and the concussion was so great that it would actually lift a person from the ground, if you were caught unaware by the firing of a round. Everyone I served with has hearing loss and tinnitus, but I have never known of ANY Vietnam vet being diagnosed as having TBI. Could TBI explain some of the symptoms in Vietnam vets which VA attributes to PTSD? I have always felt that VA preferred to diagnose Vietnam vets with PTSD rather than to delve into the long term effects that chemical warfare might have on our mental conditions, could TBI be the same? Could it be that the VA prefers to diagnose PTSD in vets rather than physical brain damage, because the PTSD diagnosis automatically discredits the vet and gives the VA the upper hand in all later interactions with that vet? I have always thought that was the case. Of course, I am a ragged ass unstable old Vietnam vet diagnosed with would PTSD, what weight would MY opinions have?

ron, you raise good points. maybe some day papers will be found showing under the table deals with chemical manufacturers buying off the government in exchange for ptsd ratings. but, let’s not let this idea take away from the fact of your ptsd. i can see how the diagnosis as valid would help them distract from chemical poisoning that is additionally disabling. that would be a great way to protect the trillion dollar chemical warfare industry and the rest of the normal industrial chemicals they make.

Ron, as I read this fine piece of investigation, I too wondered how many Vietnam vets are affected by TBI. I was within 20 feet of a 122 mm rocket upon impact. I don’t remember the actual detonation, I “came to” with my head ringing and I couldn’t make out what anyone was saying. Luckily, only a few small pieces of shrapnel hit me. For several weeks I had some memory loss and headaches. I have been diagnosed and am compensated for PTSD, so I too wonder is it just PTSD or is it TBI or is it both.

Very good research and report by Benjamin. I just got off the phone with the American Legion, a supervisor called me back, about the Oakland Regional Legion hanging up on me yesterday. I am 100% for ptsd, and have moderate to severe tbi, but the VA has dodged the tbi for years, and this should interest anyone with a similar situation.

what the VA did to me was warn me that the tbi evaluation they had me scheduled for could lower my ptsd rating, so this is the opposite tactic that your review on this says: namely, Ben, you have exposed how the VA will emphasize PTSD to get out of a tbi rating. sick bastards and their catch-22.

in my case the VA and the contract neurologist both told me that I had a big risk of losing my PTSD rating if neurological exams said tbi was my real problem. then, they said it might turn out to be tbi so you could end up with no rating. i talked to the neurologist several times by phone, largely because i could not remember what he said each time, then again the night before the exam. it was obvious he was a hit man contracted to knock off my whole claim.

all the while the VA had been saying not to risk a tbi evaluation because it could cause them to lower my ptsd rating on the premise the tbi eval would include a new ptsd evaluation. as we all know, if a vet came to them in shock, unable to talk or move, with half of their head missing they would say it wasn’t tbi and it wasn’t ptsd, it’s probably a personality disorder or some krap like that.

so, after all the mind games then talking with my wife we decided to cancel the tbi evaluation. next thing i know a letter shows up saying i have been scheduled for a periodic ptsd evaluation. the VA was obviously going to shaft me out of my rating. i did not go to the evaluation, then the VA said my rating had been cut off. fortunately, due to the timing of how long i had my rating i had recently received a letter from the VA saying that my ptsd was permanent totally disabled 100% relative to the 10 year rule of it being in place that long.

i had to use that letter to get my rating re-estasblished and fortunately there was no lapse in comp payments. much of this happened because of the congressman i had at that time was a veteran hater and fortunately he retired. because of unusual reasons Senator McCain had been involved and it was his office that kept my rating from being cut off, which he accomplished by using the letter I had just gotten through his action that said my rating of 100% was irreversible/permanent.

the games never end with the VA. reporters are questioning the white house press secretary right now, the morning after shinseki testified to congress yesterday. the reports yesterday indicate this could actually shake things up at the VA for once and for all. fire everyone at the top and start over, then fire the news ones until we get competence at the VA. criminal charges will help on that.

it is hard to tell, who is worse, the jerk sitting next to shinseki yesterday, or the guy with the wavy white hair that said preliminary findings show there were no deaths that could be tied to a secret waiting list, or is shinseki the worst of the three? answer: all of them! maybe these are the two top aides that have been targeted already for firing along with Shinseki. i know the one seated next to shinseki is diabolical and has already been caught doing horrible things to vets himself. for sure, the three of them need to go!

BW, It is hard for me to read this because of my messed up brain and vision. Caught that incapacitated vet will be designated with personality disorder-yeah-they have always done this to us vets. So, are you saying that you had the PTSD rating, filed for TBI but were threatened to lose PTSD rating…so you cancelled the TBI and fought to get the PTSD rating back? Jesus A. Christ! I’m already confused enough. Doesn’t TBI (Brain damage) constitute PTSD?
Please explain why the VA wants to rate PTSD instead of TBI. There are so many vets with both issues.Thanks.

Presently, I am working on claims due to the Chernobyl nuke disaster and the radiation cloud that went over where I was stationed in West Germany and working with the DAV. I guess I will see how it goes since I have so many medical issues now days.

Ben, with all we have seen and learned in just the past few months and weeks with these latest scandals is that a institutionalized culture of f\Fear of Retaliation exists among the many VA doctors and employees. All these whistleblowers in different parts of the country, and even those few before them in recent years have all said the exact same thing. As I’ve always shared with you: The real truth often begins with a majority of one. That single fearless person who is willing to speak out against all costs and odds. God does the rest when the truth is spoken where falsehood suppresses the truth.

There’s are sure things we can conclude from this VA management crisis and fiasco. One, that there is widespread practice by VA management to compel rank and file doctors and employees to lie to comply with demands. And if they don’t lie, they were punished in several ways. The motive and purpose had to do with getting bonuses and promotions. Read more money, more power, more prestige. But at the VA this bureaucratic thuggery apexed to a fine criminal art. And honorable, innocent veterans died as the direct result of these criminal civil rights violations.

We know from common wisdom and understanding of such criminal behavior that those who demand that others below them lie, must also lie to themselves and those who are above them. And Like the prefect fool, Shinseki clearly believed all these lies for too long.

Something more needs to be said about the many VAMC, VISN and VACO executives that demanded this falsification of records. For a long time we have heard these same criminals sing us their song of praises, which refrains over and over that VA healthcare is among, if not in fact, the best in the USA. But now we see that this self-laudatory song was written based on the false statistics fed to them by the many VAMCs and outpatient clinics. There is only one conclusion. The whole of the VA’s projected image is a house of cards based on false reports of timely service delivery, and certainly much more falsification in many other areas. When criminals are successful in one area of crime they widen its reach for maximum unearned reward. We therefore must question all areas of statistical reporting on VA healthcare delivery. Successful fraud becomes an enterprise. Especially where bonuses and promotions and perks are involved. That sin of greed.

That less than 7% of all veterans enrolled in VA for healthcare ever participated or “responded” to the VA’s touted surveys speaks its own condemnation. Its unthinkable for anyone to use polling sample techniques to measure survey accuracy in something as complex as healthcare. No professional survey service I’ve spoken to endorses the empirical methodology and basis that VA’s in- and out-of-house surveys have used. And yet in spite of these professional criticisms, the VA fraud artists insist on panning off on us this claim that most veterans are ever so satisfied with VA healthcare. The ruse is up.

Ben, I forgot one thing that the survey pros told me. These so-called empirical surveys done both internally and externally on patient satisfaction never canvassed all 6 million veterans getting healthcare from VA. In fact, only a small “sampling” was ever taken and only some few hundred thousand surveys sent out. Of that, say, 400,000 survey forms sent out, the response rate was never greater than 5-7%. That equates to a mere 28,000 maximum in a mailing of 400,000. Rarely do direct mail surveys ever produce larger response rates, regardless of any inducement to participate, even with offers of cash. And since the surveys must be blind, there is no way to verify that the veteran to whom it was sent filled it out himself or someone else. Given the depth and breadth of the calculated fraud and deception now being uncovered in the VA, it is foolish for any of us to give any credence to any of these claimed survey results. When they tell one lie, they have to tell several more for the con game to work. We all know that proverb.
I can only say with certainty today that we veterans have been lied to for a very long time by all these VA executives from VACO down to every VAMC director and his management staff. There surely remains much more to be seen. The VA coming apart at the seams. The breaking out of the truth is nothing but answered prayers. The VA fraud has gone on so long we can be sure that it is both pathological and institutional. And as with all such exposed Liars, they will continue to lie, since they have exchanged their own lies to be the truth, and deny all truth that militates against their self-deception. Hopeless.

Our country cares more about sending money 2 foreign countries and giving themselves raises than they do about the men who make it possible for us 2 be free. Why does our President take so many vacations when people are going hungry and loosing their homes. i AM JUST A MOTHER WHO SON SUFFER FROM P T S D AND WE NEVER KNOW WHEN HE MAY LOSE IT AND HURT HIS FAMILY AND NO ONE WILL HELP HIM.

I am actually having this problem right now and really I don’t know what to do. after the marines I did go to the VA and was diagnosed with 70% TBI, I started school (art school, nothing hard for me to do) and last month I was reevaluated for my TBI. the screening took less than 2 hours and the questions seemed more around the lines of a PTSD screening. this month I have received a letter from the VA to propose that my TBI 70% be dropped to 10%. when I read the letter the doctor said I was having headaches once every three months even thou I told him 4-8 every month. he also stated that going to school counted as work. right now I have are congressman involved to look over every thing for wrong doing, but there saying right now that I should send in more medical research to validate my claim but all my medical was done in the va and I can not afforded to go and have another MRI or catscan to show them what is already there. I am just trying to get more information to help me because its happening to me its happening to others and getting screwed is getting screwed, and I am looking for as much advice as I can because I am lost right now.

I am having the same problem I was 100% for TBI I got reevaluated in November 2013 and they removed my TBI completely and I got 30% for migrain headaches the doctor said that he could not if I had TBI or PTSD. When I was rated 100% that was with residual of seizure. When getting reevaluated I let the doctor know about the seizure and he said that he could only talk about my headaches…right not I am in the appeals process and I have filed a claim for just my seizure because with just seizure alone I should be at 100% I looked up the reg and it say 1-2 a month rated at 100%.. The funny thing if I received a purple heart for the TBI so how can you tell me I don’t have one….this is a load if crap for us to be fighting for benefits that we are untitled to, we already fought for them just give them to us….

Beware of depression setting in. Most who take a TBI don’t associate the depression that comes later with the injury. Depression is one of the five approved disorders for secondary TBI compensation. Depression is real and it can destroy your life. Spend a few thousand dollars on a REAL TBI assessment at a private clinic. The VA screen is worthless and designed to mitigate claims, not define TBI damage.

You will have to go to a private clinic and spend 2k for a full battery of tests to get a baseline of damage done by your TBI. Another 3k for 3 days of testing to map out the damage to your executive functioning too. There is no way the VA can tell ANYTHING of the impairment by using that bullshit one hour screen or any two hour interview. These are NOT professional doctors schooled in TBI assessment, these are VA HACKS schooled only in claim denial. The two day 2K assessment should be more then enough to put anyone like you over the top. You simply can NOT allow the VA to continue to do these things because this is driving our brothers and sisters to suicide. Especially the brothers and sisters who have sustained TBI as they are at far greater risk do to the inherent depression issues. If you haven;t gotten an MRI from the VA or even if you have get another one OUTSIDE the VA. The VA never sees the frontal lobe contusions that spawn depression and a myriad of other things.

Im wondering if I would recieve va compensation from my severe TBI in 2007?

I discharged from USCG then 11 months later I fell from a 10 ft. ladder. Doctors removed 1/6 of my skull & was in a coma for 6 weeks. I had to relearn life completley. I have alot memory & cognition problems.

The VA will deny that the injury even happened if they can. They will refuse to do any MRI if it means uncovering damage. They will take you into a one hour TBI screen and tell you how bright and intelligent you are despite the worst scores imaginable. Expect them to screw you the forst time around and then get a lawyer and try to find medical help outside the VA that is interested in your HEALTH and your QUALITY OF LIFE because the VA only cares about claim denial.

And FYI; The reason why they took off 1/6th of your skull was to keep the subdural hematoma from killing you. When a subdural hematoma sets in the blood pressure presses your brain down onto the rear deck area of your skull where your spinal cord comes through. The first part of the brain to impact bone controls one’s heart rate and respiration. When it happened to me my blood pressure cratered. The VA will tell you that you weren’t in a coma, that you were just sedated for the operation to remove your skull plates to alleviate the pressure build up from the subdural hematoma. OBTW, a subdural hematoma is spawned when blood pours through rips and tears caused by the injury.

I had a TBI in 1977 that spawned a subdural hematoma that very nearly took my life. I was in a coma on a sickbay table for 2-3 hours as close as the information I came up with could determine. I was kept in service and began experiencing severe depression which has destroyed my life and left me homeless too many times to remember. November before last another vet said that I should research the post TBI issues. After 6 more months of incapacitating clinical depression I began my research in the late spring. WOWA! My entire psychological history poured out before me. I went back to the VA and told them what had happened and they did NOTHING but a one hour screen. No MRI, no further assessment despite the fact that the screen itself in fact did point out a few areas of damage. The “doctor” whose clinic did the screen used the excuse that my depression (not that bad that day) accounted for my extremely low processing speed and other excuses for other scores that were too low. The incident report went missing for the injury however the chief corpsman insured the facts would be known by having entries made into the deck logs detailing my short stop into a neuro trauma clinic. No further medical treatment was allocated, no assessment of PTA, AOC, or anything. I was well enough to continue my duty and that was that. The VA is PURPOSELY denying me an MRI because they know from my account that the residuals of the subdural hematoma will be found. In addition from my research I suspect that contusions to the frontal lobes and dural scarring will be seen too. So they shot down ALL my TBI injury and secondary MDD stating “no clinical evidence to support”. Of course there is no clinical evidence, they refused the MRI that would have provided the evidence. I have a law firm working on this now. That injury DESTROYED my life and the VA is just LYING as hard as they can to deny me my the grace of the American people.

What must be emphasized here is this; People who sustain TBI injuries and whose emotional and executive function states are impacted RARELY ever make the link back to the injury. The VA knows this and takes off people for their benefits like a mugger targeting a drunk. That is the moral compassing of those in the VA who tend to these things. People with post TBI issues like mine are informed throughout their life that something is not “right” with them but blow it off and just live assuming that they fall into some fringe “normal” category. They don’t! My depression was just passed off as a bad day, week, month, then I blamed the Navy and my service, then I blamed my bosses and events at work in my civilian life. Typical symptoms of post TBI issues are running through a number of jobs in relative quick secession, then going months or year without any employment, then back into numerous jobs that don’t last for but like 2-6,7 months or so then another round of unemployment for months or years. This happens regardless of any substance abuse issues. The VA tried to get me to malinger a chronic substance abuse disorder that never existed. I am no angel, but I have never been addicted to anything short of nicotine. I made determined effort to keep a job for 5 years at one point and succeeded. However the inability to establish any meaningful relationships at work (or privately for that matter) are another symptom of post TBI issues. The crash began 2 years into that job and cascaded onward and downward for another 7 years where it bottomed out with an eating disorder, a homeless shelter and the loss of EVERYTHING I owned. During that entire period and for some time yet to come there was absolutely NO drinking or any drugs at all including pot. When I detailed those years to my VA therapist she omitted them from the medical record. That information did not conform to their denial of the TBI. Eating disorders too are a post TBI issue symptom. So now I have a private health care provider who will do the MRI and further assessments of not only my depression, but the damage done to my executive functioning as well. The VA is NO PLACE for ANYONE who is seeking answers as to the damage their TBI caused because the VA will LIE and LIE and LIE and LIE and LIE.

These comments for TBI are really getting me nervous for my upcoming TBI C&P Exam in a couple days. Really hope I don’t get screwed over but from what I’ve been reading, looks like I will either get a zero rating or just denied all together.

Im up for re eval for TBI that was updated today by ebenifits. They didn’t tell me, but luckly I caught it today and called into the va. What should I expect from the re eval for tbi and what should I do to maintain the rating of 70%? I do not want my benefits taken from me like all of you.

Over 12 years in the military I had 4 different TBI’s that were all unique to themselves. I do get some attention to problems but recently the standard meds given are not helping and I have been experiencing more severe symptoms and as usual the VA is to busy to attend to this so I went thru the Choice card system. I am over the 40 miles and 30 days but here is the best part. I called the choice program on 26th of April and explained that I have never had an MRI or CT done on my head because these injuries were done in the 70’s before technology for MRI or CT. I have migraines and seizures all the time and they are getting worse. Today is the 26th of May and I have called them every 5 days and still one excuse after another. With the Choice system who do I seek after waiting 30 days with them. To think they are a 36 billion dollar program and they can’t take care of just me or are other VET’s experiencing the same delays as me too. Just a little frustrated. But medically and physiologically I’m a wreck and running out of options.

This conspiracy over TBI has spilled over to the general population. North Carolina has ignored a TBI diagnosis of my daughter, and my attempts to advocate for her and their mistreatment of her by involuntarily addicting her to benzos has led to retaliation against us both – taking her CHILD AWAY FROM HER – while continuing to damage her brain!

I have done quite a bit of digging into this issue myself, and I had guessed that the state, constantly complaining about the lack of funding for support of TBI survivors, had started manipulating evaluation results to deny TBI diagnoses. After all, medicare and medicaid pay for drugs and our local health agencies seem to love forcing citizens to take these drugs and labeling them “seriously mentally ill.”

Our State’s TBI Council report even admits that the state lags far behind others in providing support for TBI and as a result many are ending up homeless, permanently disabled and in psyche wards.

Psyche wards are traumatizing and although PTSD does go hand in hand with TBI, treating the TBI with proper care and compassion helps alleviate the PTSD. Ignoring and mistreating the TBI exacerbates the entire problem.

This entire situation has been pure hell for my family and I hope to find legal help. Not only is my daughter being mistreated because veterans are being mistreated, but she has been waiting over 20 years to receive benefits from her father’s death caused by agent orange exposure.

What this country is doing to veterans and their children is criminal in more ways than one.

I just had a neuropsych appointment. My polytrauma doctor diagnosed me with mtbi from a mortar attack in 2007. I went to my neuropsych and he told me I do have minor memory problems but they are related to my PTSD and drinking. Not to sure what to make of this and not sure if this will screw with my pending claim

I had a closed head injury while serving in the Navy reserves several years ago and was discharged because of it. I pursued a VA rating with the objective of getting 10% in order to get VA medical care. I was awarded 0%. I appealed it and was sent to a VA neuropsychologist who had me do a bunch of puzzles. When I got the report back she said I had avoidant personality disorder – basically calling it a pre-existing condition. She never asked me one question about my life up to that point and in fact cut me off when I talked about anything saying it was unnecessary because the service connection had been established by the 0%. When I called the patient advocate all he did was tell me about all the hoops I’d have to jump through to request another evaluation and even then the original report would remain as evidence against me. It felt like they were all in cahoots I never wanted to believe the VA was so crooked, but it is. If anyone has any advice I’d appreciate it. Thanks.

I was involved in a humvee accident in the field while in a convoy. I had a concussion and can’t recall any of the details . This happened in l992 . I have severe headache and to say the least my judgment and life has never been the same since. I ets in 1993 and filed a claim and was deneid. I later join back in the army and was discharge on a oth discharge for misconduct and awol.I feel my judgement and mind was not right from the day of the accident. I have not since been able to focus, hold a job,very depressed. I had a Mri done at the VA where spots where found on my brain and the va plays it off as normal for a 45 year old male. I have been going to the tbi clinic but when they gave me a psychological exam he said it came back inconclusive? ? I know the concussion I got in the military has affected my life dramatically and with the evidence of spots on my brain from tramua the still want admit I have a tbi . Now the sending me to mental heath. Please advice of best way to get benifits. I know the va is screwin g. Me.

MY NAME IS WIL. I KNEW ZERO’S WORTH OF THE VA IN DEC 2008. I WAS WAITING FOR AN APPOINTMENT FOR OVER 2 HOURS AND WAS ALREADY PISSED SO I STARTED PACING AROUND THE VA HOSPITAL PICKING UP ARTICLES LAYING AROUND AND READ THEM. CAME ACROSS THIS TBI ACRONYM AND DIDN’T KNOW WHAT IT WAS. WENT TO THE LOCAL LIBRARY TO CHECK IT OUT AND I NEARLY FELL OUT OF MY CHAIR. I SAID TO MYSELF, ‘I HAVE THAT AND SPENT 11 DAYS IN A NAVAL HOSPITAL’. I EMAILED NPRC, GOT MY MEDRECS, WENT BACK TO THE HOSPITAL JAN 2009, FOUND THE LOCAL VSO. HE FILLED OUT THE FIRST FORM WITH A THOUSAND PAGES AND THEN I GAVE HIM MY DD214 COPY PLUS THE MEDRECS. AND I STILL DON’T BELIEVE ON JUN30/2009 I GOT A CHECK IN THE MAIL AND A 50% DISABILITY RATING WITH RETRO ADDED. NOW I KNEW THEY WERE HOLDING BACK. GOT MYSELF A DC LAWYER AND I AM GOING TO FIGHT THEM FOR THE REST OF MY COMORBIDITIES. DON’T GIVE UP THE SHIP!!! AND DON’T GIVE UP THE FIGHT!!!.

FELLOW VETERANS I HAVE A FOLLOW UP IN REF. TO MY INITIAL INFO. THIS AM I RECEIVED NOTIFICATION FROM DAV THAT I HAVE JUST BEEN AWARDED 90% PLUS 100% IU. GENTLEMEN DON’T GIVE UP THE FIGHT. MINE HAS LASTED 8 YEARS AND ITS NOT OVER YET. FIGHT FOR YOU BENEFITS!!!!!!!!!!!

I was injured in Okinawa in 1980 when i fell almost 20 feet to the tarmac off a p-3. I got out of the military and went to afees station and they said it was all in my head. Now after 35 years i am still living day to day with this horrible problem. The va wont do anything about it. so if you think your getting disability for it, good luck. i feel bad for all you vets that get out of the military with tbi because they wont’t do anything about it. I just hope all that have tbi gets what they deserve. I am still battling with them and without 3 witness from people your chances are null and void. it just pissess me off that the military knows and wont help. I guess you have to get congress to help if your lucky. Get a lawyer as soon as possible. Again i feel so bad for our troops that put everything on the line without any help. Good luck my fellow vet’s, They screwed me and they will go on trying to screw everyone along the line.

This is Michael Thomas again letting people with tbi and ptsd’s That if you get married and have children that you for the most part won’t even remember raising your kid’s. Which is really sad. I feel so bad for my children. Also you won’t remember the details about a movie you watched the week before. This Tbi business is no joke and the government won’t help you out one bit. It’s so sad like i wrote in the above statement. I just don’t recommend letting your children join the militay because they will use you up but they will not take care of you in the end. So again parent’s don’t let your children go into the military unless they have a desk job!! Again the va has treated me so unfairly. don’t let it happen to your loved one.

I was screened for TBI and only got 10 percent for the chronic headaches. I have them every day as well as gained poor vision in one of my eyes. I recently went to get a second evaluation and was wondering how long does it take to get the results back from the nuero screening and if there would be any other screening associated with this.
In Iraq three motors or rockets went off well moving vehicles in the motor pool. as the blast went off I was nocked into the moving vehicle lost consciousness when I came too I put my caviler on and was escorted back to my room. In my room still confused and in shock of the incident I took my helmet off and had blood everywhere. I didn’t now what to do or even notice that it was a lot of blood till they checked on my to see if I was alright after the blast. they gave me some staples and put me on administrative duty. there was no screening no x-rays or anything. as well went threw a few blast encounters in which nocked me into other vehicles without any visible head trauma. I was only rated 10 percent. and 50 percent PTSD.

I am sick to my stomach as I read your article and the comments that followed. My son served three tours to Iraq with the USMC from 2002-2006. He was involved in several blasts during those tours being knocked unconscious for undetermined times in both incidents. He was discharged in 2006 and came home a changed man, of course. We knew he had PTSD and consumed too much alcohol but at that time there was NO mention of traumatic brain injuries ( and VERY little education on PTSD). To make a long story short, he suffered for five long years after he was discharged. He held down a job at a National Cemetery and bought a house and was in the process of rehabbing it. He was in a relationship with a high school sweetheart. Things looked “ok”, not great, but he seemed to be coping better. I want to tell you all that there is a fine line between alcoholism and PTSD. Throw a TBI in on top of all of that and you have a lethal combination. My son took his own life on 1/3/12 at the age of 29. He was the light of our lives. He was the whole package, good looks, a great personality, a heart as big as they come, just a delight to call my son. As I said, I knew he suffered from PTSD and knew that he was being seen by the Dayton Ohio VA Hospital for years. After he passed away, of course I was looking for answers. In the note he left, he described himself as an “ugly monster” and could never get out from under the demons of war. I immediately requested his Marine Corps records along with his medical records. That’s when I read about the blast situations and that the Marine Corps actually diagnosed him with a TBI…..which happened on his first deployment. He was deployed two more times within 3 months of returning to the states. This alone is inhumane. What is even worse, the Marines sent him back two more times AFTER the TBI diagnosis. From what I have read it takes about 18-24 months for the brain to begin to heal. BEGIN to heal. He was subjected to many more blasts in those next 18-24 in those next deployments. His brain must have been mush by the time he got back. The absolutely criminal part of this is that HE was never notified of the diagnosis, nor ever treated for it. WE, his family, were never made aware of the diagnosis either. This poor Veteran suffered enormously for ten long years, four years of active duty and the next six years after he was discharged wondering what in the hell was wrong with him. And so did we. My point is, we all depended on the VA hospital for his care. That was the biggest mistake of our lives. Had anyone who was seeing my son even bothered to open his medical records and see the actual TBI diagnosis, hopefully he would have been treated for it or at least, been told about it and tests would have followed. This treatment is absolutely criminal. I continue to advocate for my son and for all veterans who have been treated with no respect and receive none of the care that they so deserve. I am currently fighting for TBI benefits posthumously for him in the hopes that I can start a memorial foundation in his name so that he and his service to this country will never be forgotten. I’m not holding my breath that anything will actually transpire, but I feel my son’s situation needs to be recognized and acted upon accordingly. We ALL must fight for the rights and best care available for our veterans. You are never forgotten by this Marine mom…..Semper Fi.

My heart breaks for you as it does for the families of the other 22 or more veterans who commit suicide daily. I too have become a strong veterans advocate because of the lack of treatment they so deserve. I’m am so sorry for your families loss.

“Mild” head injury is a scratch on your face while shaving. The idea of a devastating injury to the brain/mind -yes,they are connected (like a magnet and it’s magnetic fields)- being called” Mild”, when there are overwhelming medical publications available on PubMed web search site at the NIH,and other places. The damages can shoe up much longer after it takes you to get off the exam table. This is a cover up much bigger and worse than Watergate.You don’t need much medical training to recognize the words used by honest medical authors who detail the serious drastic symptoms that the Government wants to hide.
If you believe the dictadocs and the beaurorats of the military-industrial-medical-and everything else,complex ;that President Eisenhower warned against, you brain/mind is really injured. Don’t take my word for it. Check it out yourself. I’m only an advanced medical professional who has been on TV,papers,medical journals,conferences,federal hearings etc. TBI, is short for :The Big Injustice.

Dr. Casey:
I am a Vietnam Veteran that suffered a TBI on 30 July 69. In same explosion my A-gunner was killed, due to losing part of his head.
Was Medevac’d to Da Nang Naval Hospital. I was out for a few days and when I came to I found out that my A-gunner had died from his injuries. After being released back to the Bush I suffered migraine headaches constantly and very rarely slept. I had Insomnia and my eyes were constantly in tears. Finally I was sent back to Da Nang Naval Hospital to get checked out from the initial injury. I was prescribed medication that was supposedly so strong that I was instructed to only take 1 a day. Was told at the hospital that it was so strong that it could knock an elephant down. Well I took the entire supply of pills in 3 to 4 days, an amount that was to last 30 days. The pills did nothing for my headaches and insomnia.
Over time the headaches let up some and the insomnia got better but did not go away.
When I got out of the Marine Corp I went for a C&P in Lubbock, TX. The doctor fed me so much Bull S–T that it was better.
I was so Damn Mad at the VA for the treatment I received, I never went back.
Throughout my life I have endured headaches (Migraine) and bouts of Insomnia and the VA still denies I have problems.
I have been diagnosed with PTSD at 50% but nothing for TBI.
Now I have been doing some research on my own and I have read that PTSD can and is a result of TBI.
When I got out in 1970 no one knew of TBI or PTSD.
Now today both illnesses are a known fact and VA does its best to Lowball a Veteran in its disability ratings.
Also I believe that I have a valid claim for TBI that should go back to my initial C&P Exam in 1970.
Trouble is I do not know who to turn to for help as my VSO appears to be worthless anytime I ask him about possibly filing for TBI. He says I am getting all I am entitled to!
If you or anyone can lead me to someone that can help, my family and I would be extremely grateful.
Dr. Casey if you need me to contact you I will keep up with this Blog.
Thanks,
Joe Jr. USMC

Joe. There is medical help,and there is money. With medical help first, you may be in a better able to grab the dough which is rightly yours. TBI,PTSD,Migraines,etc have been treated with some success, by some practitioners.But they probably don’t get their thirty pieces of silver from a government agency, or some profit making “non profit” front group. if you have an email, I can give you some leads that might help. You can pick up a “throw away” email,and let me know it on this blog. Dr. Ben.

I have been trying to tell people the same thing for five years.The VA diagnoses PTSD over TBI to avoid the total and permanent rating. Our NSO suspected a TBI in my husband. Husband is a 4 tour Army Vietnam veteran. His brain shows damage in brain scans.He just recently got a rating for 10%. He has been rated for PTSD since 1998. He had to fight his way up from a 0 percent rating in 1983.The decision said he had a personality disorder. He also got angry and refused to go back to the VA . VA has “lost” all of his paperwork from this prior decision. He then tried again in 98′ he was given a 30% rating for PTSD, after a couple of more years appealing this decision they finally gave him 70% PTSD, 30% unemployability. 10% percent for a gun shot wound to his hip, 10% for his shoulder from a claymore mine incident that knocked him unconscious with lots of shrapnel through out his whole body. He was also shot in his helmet. We have to had to fight our way up the latter to get the rating he deserved . When I say fight I mean fight. Two years ago they tried to take his rights away from him but trying to rate him “incompetent” a “mental defective” in their words for his PTSD. We appealed that but the VA decided to not peruse it at the time of the hearing. No one who has fought for our country should never have to fight another battle with their own government. I could tell you true stories all day long about the injustices our government has done to our veteran’s. My main concern now is my grandson who lost 40% of his hearing in one ear from an IED blast he sustained in the Helmond Province in 2010. He was a Marine. They VA gave him a rating of 50% I believe on the first go around. Too quick and too easy. He needs to be checked for a TBI. I once again say, too many PTSD diagnosis and not enough TBI diagnosis. I would be happy to talk to you as I have done with a few other reporters who say the want to help but never really do.

My humvee was hit with an ied, eod determined it was equivalent to 50 lbs of tnt, came to with both ears bleeding and couldnt hear for weeks. Couldnt walk a straight line, couldnt remember what was being discussed in even the most simple conversations, was constantly dizzy, extreme headaches.. I was a zombie for years. Would literally faint if I was out in public and the crowds were too large. I still have problems. Its a miracle I had the strength to not eat a bullet. DOD diagnosed me with moderate TBI and PTSD. They sent me to examinations for 2 1/2 years before medseping me. Every single military doctor diagnosed me exactly the same. But I couldnt be medsepped until I was given a va rating and they would only send me to civilian clinics for that. Even they all agreed moderate TBI and PTSD. But the one civilian that was in charge of compiling the paperwork put me down as having ‘schizotypal personality disorder’ (which I cant wait for them to try to use that as a reason to confiscate my fire arms, i may be a mess but theyll need atleast a damn platoon) and tinnitus and gave me 50% and 10%.

And ever since then the VA has been trying to take my disability away. Theyve made me go for reevaluations so many times in the past 8 years that Ive completely given up trying to fix the situation. I know other veterans with severe combat related problems who the VA lost their packets on them and when they went to fight it they were told that they should have put the paperwork in when they separated and now its too late. Theres a special place in hell for these people.

LETTER TO THE EDITOR OF THE JOURNAL OF NERVOUS AND MENTAL DISEASE
By Lemuel C Bray & Melanie Stroud

Validity and Peer Review Complaint
I would like to register a complaint about the validity of the conclusions and the peer review of: PSYCHOLOGICAL TESTING OF CEREBRAL MALARIA PATIENTS, “The Journal of Nervous and Mental Disease,” vol. 147, #6, 1968 by Kastl, A.J.; Daroff, R.B.; and Blocker, W.W.http://journals.lww.com/jonmd/Abstract/1968/12000/Psychological_Testing_of_Cerebral_Malaria_Patients.4.aspx
Why worry about the validity of this study?
Because the focus of the treatment of the victims of cerebral malaria has long been “behavioral” instead of “organic” in the United States and, because, the Department of Veterans Affairs relies on this study to deny compensation to the victims of cerebral malaria. I would therefore, like the Journal of Nervous and Mental Disease to make a full retraction of its validation of the Kastl, et al. study.
The problems:
No valid control group for the conclusions:
“Upon recovery no measurable organic residual was found.” (pp 553) “Certainly the directions of the obtained results suggest common impairment for cerebral malaria patients, and the fact that there are no significant differences when both groups have recovered suggests there is no organic residual.” (pp 557) And “In addition, we feel the present results provide substantial evidence of the absences of residual organicity in cerebral malaria. On every test and measure but two, the performance of the cerebral malaria patients when recovered is either indistinguishable from, or superior to, a group of matched malaria patients without cerebral involvement.”
Both groups had the disease so it cannot be concluded by comparing them that the disease does not cause residual impairments.
The first key that there was a problem with this study was the following statement on pp 554: “The fact that the M group reported significantly more disturbance during youth (e.g. having been in many fights, having had trouble in school) can probably be understood as an attempt to exaggerate pathology, in order to increase the likelihood of being medically evacuated to the United States. (The patients with cerebral malaria were aware that their more serious condition would necessitate evacuation.)” This statement goes against reason. If the patients wanted to be evacuated they would exaggerate their premorbid wellness and denigrate their post-morbid condition not the reverse.
A study of Table 1, pp 554 shows there is a deficit in “Years of schooling” for the
M group. Do the math and you find these results:

Essentially, after casting out the equals, this study compares four tenth grade drop outs in the M group with four high school graduates in the CM group and then concludes; because the cerebrally involved high school graduates had IQs only slightly lower than the non-cerebrally involved tenth grade drop outs, the high school graduates displayed no lowering in IQ????

And as for the disturbances in youth, isn’t it expected that 10th grade drop outs will have more difficulties in youth than high school graduates? Why wasn’t the military induction battery of tests used to determine the pre-disease IQ levels for matching these subjects? Percentile rankings could have been
used to match both the diseased groups M and CM with a legitimate control group which did not have the disease p. falciparum malaria which is synonymous with “cerebral malaria” according to the pathology texts cited below.

Blocker, Webster W., MD et al.’s report on the same 1200 p. falciparum patients noted a patient who developed a “paranoid schizophrenic reaction” “one week after becoming afebrile.” This patient’s symptoms continued and were conveniently discounted as a “functional psychosis,” not related to his malaria diagnosis. (THE PSYCHIATRIC MANIFESTATIONS OF CEREBRAL MALARIA, The American Journal of Psychiatry, vol. 125, pp 192-196, 1968) This report leads one to question if the U S Army had a pre-determined desired outcome of the Kastl, et al. study. The reason the Army might do this rests in the inability of the cerebral malaria victims in first getting beyond the denial of any deficit (thus not knowing they had been damaged) thereby allowing the Military the opportunity to avoid the compensation of the victims.

Think of ETOH intoxication. It presents a global brain deficit which is not recognized by the intoxicated. (As in the trouble of getting the car keys away from an intoxicated individual) Cerebral malaria also presents a global deficit but from occlusions of the brains capillaries with the casts of red blood cells emptied by the parasite. (See the pathology texts cited below.) The difference is that ETOH intoxication is usually a passing chemical or drug effect. The occlusions from cerebral malaria infection block oxygenation of the affected brain cells and thus some permanent damage probably occurs.

AN ADEQUATE PREMORBID POSTMORBID comparison has not yet been done. The global nature of the damage would make adequate assessment by post morbid testing difficult. (Otherwise why use a comparison group at all?)

And finally, I question the reliance on pre-motem examinations to override post mortem findings for making a diagnosis of “cerebral malaria.”

Post mortem examinations record p. falciparum infection as synonymous with cerebral malaria. Please note that considering the pathology of the disease the most reliable indication of cerebral involvement would probably be a body temperature over 104, severe cramps and headache. The occlusions that occur in the brain also occur in the muscle tissue at the same time causing the cramps. There may be no other discernible cerebral signs because of these symptoms except a post morbid indication of amnesia which could easily be missed unless the examiners are specifically looking for it. Amnesia appears to be a function of the reality check area which also seems to be responsible for recording long term memory.

Discussion of problems created by the Kastl, et al. suspect study:

John Booss, MD, Department of Veterans Affairs National Director of Neurology at the VA Connecticut Healthcare System in West Haven, CT, in his testimony before the Subcommittee on Benefits, House Committee on Veterans Affairs , on July 16, 1998 stated:

“Malaria is caused by infection in the human with a parasite of the genus Plasmodium. The diagnosis of malaria is made by examination of blood smears for the parasite. Humans are infected with Plasmodium through inoculation by the Anopheles mosquito carrying the organism, which it received by biting an infected human. There are several species of Plasmodium, one of which is Plasmodium falciparum. Infection with Plasmodium falciparum leads to falciparum malaria and is the cause of “cerebral malaria”.

Nils R. Varney, Ph.D., Director of Training at the Iowa City VA Medical Center, in his testimony before the Subcommittee on Benefits, House Committee, on July 16, 1998, stated:

“The results of the study suggest that cerebral malaria may have multiple neuropsychiatric symptoms which could be problematic years after the acute illness had been “cured.” As compared with wounded veterans who did not have cerebral malaria, the 40 Vietnam veterans who participated in my study who contracted malaria manifested substantial problems with depressive mood, “personality change,” feelings of subjective distress, memory problems, emotional labiality, and neuropsychiatric symptoms very similar to small seizures, such as memory gaps and staring spells.

Although these findings are statistically and psychometrically more sophisticated and reliable than the clinical observations reported over the previous 2500 years, our study is only the most recent to suggest that cerebral malaria1 is a cause of long-standing neuropsychiatric symptomatology in adults who survive the illness.”
“The message to be drawn from this research is that there may be some Vietnam veterans at risk for suffering from a persistent neuropsychiatric syndrome which can produce a wealth of psychiatric psychological, neuropsychological, neuro-psychiatric and neurological symptoms.”

Rezek et al. Autopsy Pathology’s definition of Cerebral Malaria: “Cerebral malaria is synonymous with P. falciparum infection but not all cases show gross evidence of the disease. What may be found are petechial hemorrhages on the surface and in the white matter, and a diffuse grey or leaden hue to the whole brain, especially the cortex.

Dr. Varney used “cerebral malaria” in REZEK’s more glogal sense which is supported by SPENCER et al.’s Tropical Pathology.

The narrower meaning, used almost exclusively by the U.S. Military and the DVA, that the patient showed very definite neurological symptoms (delirium, etc.) during the acute phase of the illness, was used by Dr. Booss in his citation of the Kastl, et al. study to denigrate Dr. Varney’s testimony.

A study of Herbert Spencer et al.’s Tropical Pathology, pages 329 to 439 on the “Pathology of Acute P. falciparum Infection” reveals that the parasite invades cellular tissue early on in the acute phase of the falciparum infection.

“P. falciparum infection in the non-immune commonly has a short course if untreated and death may result before any immunity can be established. The picture seen at autopsy thus depends on the duration of infection, whether the patient has had a single or repeated infection, and the prevailing pathogenic developments such as shock or hemolysis. Following treatment the parasites may be removed from the blood though the other basic pathological processes are unchanged”

Central Nervous System

“Lesions in the brain in malaria have been described in detail only in acute P. falciparum infection and black water fever.” (Black water fever results from p. falciparum infection when the casts of the red blood cells excreted in the urine turn it black in color2.)
“Macroscopic; the leptomeninges may be intensely hyperaemie and the combination of congestion of malarial pigment gives a characteristic colour which is almost diagnostic of malaria. Small petechial haemorrhages may be present on the surface of the cerebrum and cerebellum. The brain is often oedematous, increased in weight and has some broadening and flattening of the gyri. The cut surface is slate-grey, the deeper shades being found in the grey matter of the cortex and the basal ganglia. Scattered through the white matter of the brain, sometimes extending down into the cord, there may be small petechial hemorrhages and very rarely a larger localized haemorrhage. The later ventricle may be dilated and the choroid plexus is congested. Irregular areas of softening have been reported by are rare and thrombosis has not been observed in the larger vessels.

“These changes are usually most evident in patients who have died of ‘cerebral malaria’ with clinical evidence of involvement of the central nervous system. Pigmentation of the brain may, however, be seen in individuals who have malaria without signs of ‘cerebral’ involvement. The poor correlation between clinical and pathological findings has been frequently noted by pathologists (MAEGRAITH, 1948), THOMAS
(1971) suggests that the present of petechial hemorrhages correlates best with clinical evidence of central nervous system involvement.”

The above post mortem pathology and “text book statement” supports Dr. Varney’s hypothesis and not that of Dr. Booss’s denigration of the Varney hypothesis.

250,000 were victims of cerebral malaria in Vietnam. Reasonable compensation would probably cost approximately an average of $500 per month for each for life.

That is $125 million per month and $1.5 billion per year.

Since the veterans are in budget competition with the military industrial complex it is very reasonable for those corporations to make sure the VSOs are controlled by their boys and that they get salaried high enough to keep them loyal to the military industrial complex.

They probably give the “leaders” a rationalization saying that one general’s toys lost to budget constraints means more men suffering the residuals of war.

Same with the Department Affairs personnel. Buying a home for an adjudicator is a small price for what he could leave in the budget for hardware instead of humanware.

2008 IED detonated and killed 11 people and left two of us with scratches and lost limb, the next day I start bleeding from my right size nose and coughing blood, since then I started losing my vision to where I can no longer able to read without glasses, sometimes I cannot read even with glasses, week after the incident I was referred to level 2 medical facility in Baghdad where I spent 3 weeks and went back to work, 4 months later after I came home everything started a if it was day one, local medical facility didn’t have the ability to do the testings and treatment so again referred to another facility, I spent total of 16 weeks at intensive outpatient diagnosed with severe TBI and PTSD, I went through treatment and testings for two more years before the Army medically throw me out, my TBI rating at first was 10% with earing loss, vision problem and severe headache, bleeding nose till today, I asked VA to reevaluate me then my TBI rating went up to 30% however my back problem which was rated at 40% was decreased 20%, at the time I was rated at 40% I was still able to walk few yards, however at the time my 2nd rating came I was already on wheelchair yet VA knew how not to award 100% so I stayed at 90%. I am not overweight, not incompetent, not stupid, never in my life had a problem with law, my goal was to serve to retirement, this didn’t happen due to my combat wounds, yet VA still screws with me! I no longer see VA any different than Al-Qaeda and Jesh al mahdi who caused my wounds as a matter of fact VA is worst than the enemy I had the right to fight and kill, VA is there to destroy our life, imagine giving everything you ever own to your country and your country trashing you to the point where you can no longer support your innocent children mentally, physically and financially! What is the point of living?

I just completed my TBI new exam under the new guidelines. However they also scheduled me for a PTSD exam with it. The PTSD I was told my the doc was a review and nothing to do with the TBI exam. Also RO told me that it wasn’t a review. RO said they were trying to see if there was a link between the two. At my TBI exam last week, an assistant I was told would do the questions and notes then brief the doc. The doc came in after her brief to him, ask me only 5 questions nothing about my issues then had me do some physical examination, I.e.. Walk, point, listen to my chest and look at my eyes, then said ok we’re done and va will do the rest. Here’s my question to you. I thought like the PTSD doc who talk to me the whole time, the TBI doc was supposed to do the same thing ? Not have an assistant do it and the Doc gets a brief and writes the report off the notes from the assistant. Help me figure this out please. Please reply to tell me what you think. Thanks.

Tony,
I spent two months as an inpatient at the Tampa VAMC going through TBI rehab, etc. and and am retiring from AD in five months. I was called by local VA and told I have to be evaluated for TBI and PTSD as well as have another neuropsych eval for C&P; the diagnoses, etc already in my record aren’t sufficient. Just curious as to what the new TBI testing was like for you?

Russ,
Just finished part 1 of the TBI exam. Am scheduled for the 4 hour test 12/16/16. Tampa VAMC is following the playbook exactly as outlined above. I have serious doubts about the quality of care in the TBI clinic from Tampa. I seem to be incurring some kind of episodes where I get lost sitting in my house. I also have a return of BPPV. Initially I’ve been told it’s “old age”. Yeah right. I’m 64 years old and get lost in my own friggin’ house!! Guess we’ll see what happens.

I just submitted a claim for TBI. I was thrown from a Jeep in 1974,. and loss consciousness for 2 days. My two most recent MRI’s show encephalomalcia 3.5 CM to the left frontal lobe ( which squares with medical records of 1974). My medical records of 1974 show pupils react to light stimuli sluggishly. orientated but drowsy, small amount of emesis. Severe headache occurring several times a day, they are frontal (L) and ocoigental ( can’t make last spelling or word).. headache T/C tension , T/C post traumatic loss of conscious originally confused- can’t remember details of accident, bumps and abrasions on scalp post.. there are more entries on the army medical record but I cannot make out the scribble used by doctors in 1974. To this day I do not remember the accident, I was in the ICU for three days. and on discharge it was noted as cerebral concussion.. There are only about 6 different entries over a 14 day period about memory loss, headaches, and vision problems. Back in 1974, there was no such thing as TB. It wasn’t until I had to have recent eye surgery that I was made aware of damage to the left that the doctors say was caused by a blow to the head. I Knew I had been tossed from a moving jeep years ago, but do not remember the details of the accident, I reviewed my army medical records and found the above information. I do have other objective findings of, hearing loss, tinnitus,can’t sleep, short term memory loss…. etc… but who knows if these issues are related….

Do you think this basic information will net me any service connections…. Thanks

When you have your c+p exams they will ask you questions about your employment etc. to see if you have been subjected to loud noises, this of course will be used to deny your claim. If you have been employed in any trades, or subjected to loud noise you make sure to note that you have ALWAYS used hearing protection.
If you are sent to see a social worker or phsyc, anything you say will be used against you. If you have a primary care doctor outsid of the VA, tell them what is going on and provide them with the documents you have talked about. Your doctor can refer you to a memory center and neurologist for evalutation. Both are qualified to diagnose and treat TBI’s. Add the report from the memory center to your claim, and then I don’t see how they could deny your claim. What is most important here is NOT to TRUST the VA under any circumstance. Back up your claim with genuine qualified doctors, so they have no where to go and are forced into deciding in your behalf, of course that is not 100% foolproof. Good luck, I think you have a very strong case.

I had tinnitus in both ears for six years with a high pitched two tone sound, the noises are constant and have learned to ignore the ringing. Later, another sound was added, a deep tone that has a sporadic rhythm, that mimics human speech. It varies from soft and muted, to painfully clear, and loud. Have try sound machines, ear plugs, my hearing aid, and medication all to no avail rather I have a difficult time sleeping. Lately I was directed to a Doctor called Andrew WEIL on internet who provided solution to the problem. Do not be discourage, there is hope for you, it is a permanent cure to Tinnitus. Contact him with this email [email protected]

I was diagnosed with TBI by three different doctors. Two in the VA and one not. I sent in all of the Doctors’ diagnosis with all medical records that backed up the TBI claim though a VSO.
The claim was denied after 14 months stating “..there is NO medical evidence to support this claim…”
I appealed and was denied over a year later.
I appealed again and was denied for lack of evidence Again.
I appealed Again. Wait for it. They sent me a letter stating that I had not sent in an appeal withing the allotted time frame and denied that claim AGAIN!!!

I have battled this VA hamster wheel for 7 years now. I have an appeal already finished and 3 new claims finished. I have also had one actually hearing with a DRO my appeal was finished with no hearing required since they knew they were wrong denying my TBI for 6 years. I was then rated at 90 for 7 months now at 100% TDIU. I am still on the fight for making it P and T there’s no get my short term memory back anymore I’m done hoping for the happy ending. My career working on aircraft is over now because now the VA is scared to fly in aircraft I’ve been working on in fear I left a tool in it while I worked on it. I have chronic headaches in which I am still rated at zero filed an increase just recently but was brief mostly focused on my TBI which they lumped PTSD in with it. My attorney has said he cant get anything more for me theres nothing in it for him since I am at 100%. I running out of options?

I am a private practice Psychologist and Board Certified Neuropsychologist. I have reviewed the VA video on TBI Initial Examination. The MoCa is NOT a TBI screening instrument! The video is incorrect for a number of reasons. Also, I have never seen in a Medical Records (VA) review a complete TBI Examination Report like the example shown on the YouTube video. TBI is a very complex issue and not as simple as the video example would have us think. Also, the VA has allowed ARNP’s to be included in those VA providers able to do the Initial TBI exams. There are simply not enough trained VA providers who can do all the backlog of TBI Initial Exams. I have taken and passed the TBI Residuals Exam and am qualified to perform this examination but I can’t obtain the DBQ for it nor the Initial PTSD Exam DBQ nor the Initial TBI. The VA has a lock on these exams and civilian providers even those well qualified are prevented from helping vets. I am a 71 year old USMC veteran and am disgusted with what is happening to my fellow veterans. I hope the new Administration will change the system so Veterans will be able to see civilian providers. I am retired and will not see this happen but it should be done for all Veterans to receive quality care.

I am a 31 year old marine whose been trying not to be discouraged everytime I file with the VA. It took my initial TBI claim from 2010 6 years to be service connected even with a service sept. LOD in my favor. They denied it twice the. When I filed an appeal on cue they granted my appeal in 5 months and said its not a cue it was technically still open since we never sent you a statement of the case with the first denial just the second. A little upset finally being service connected I then filed for PTSD from my deployment which was 3 years after my TBI but of course it’s not a serperate issue its related to your accident even though the doctor said it was because of terroristic threats related to my deployment but she couldn’t speculate which was from my TBI or my deployment. So yes screwed again. I was rated at 70 in 2010 and then they lumped PTSD with it in 2016 and said it still only 70. Is there anyway you can help me apparently they think my TBI which is now over 10 years old will get better and it’s not permanent and total either. Another doctor said he wanted 10k before I was awarded IU and now 100% I just want to one seperate my PTSD for its own issue and two hopefully show my TBI is permanent and total my wife’s pregnant with our second so my budget is tight but in running out of options. Can you help me? I have filed for SSDI the beginning of this month because I had never even heard about it until I was doing research on getting financial help if I’m disabled and not working.

First, thank you for an excellent presentation, it has informed me greatly as to the next steps I need to take to insure continued compensation because of my TBI. Some background information; I was involved in an Army Jeep accident while stationed in Vaihingen Germany in July of 1974. Long story short, I was thrown for a moving Jeep while trying to avoid hitting a stalled civilian POV, as I came around a curve in the road. Other than this fact, I do not remember what actually happened, but I have been told by the other occupant of the Jeep that as I turned into a gas station, to avoid the stalled vehicle, centrifugal force propelled myself and passenger out of the drivers side of the vehicle. Apparently, I hit the left side of my head, and was unconscious for at least 2.5 days. My passenger landed on top of me and received no injuries. I also obtained a back injury that was rated 60% in 1986, after I retired from the US Army. In addition, I now believe I obtained neck injuries at the same time. Notice I said this accident occurred in 1974, back in those days it was noted in the medical records as a loss of conscientiousness, and hospital discharge says cerebral concussion, the term TBI apparently had not yet been coined. Finally in Nov of 2016, after reviewing my active duty medical records once again, I found this information, and decided that while I only received follow-up treatment for headaches, and back pain that it might just be time to file a claim for TBI. I went on line an filed the claim and submitted about 9 pages of handwritten medical records of that time. I attended a c/p exam in record time. The exam consisted of questions, some of which seemed silly, and some of which seemed misleading. I was asked to subtract 7 for 100, and then 7 from that sum, and then 7 from that sum until the examiner determined I was able to perform the task. Mind you I could not compute the math in my head but used pen and paper. I was asked about memory retention as well. When I tried to explain the physical injuries I was told by the examiner she was not going to address the physical injuries. On the 24 of Jan while reviewing my disabilities on ebenefits, I learned that a 40% rating had been awarded for the TBI, for memory loss and encephalomalcia involving the left side of my head.( I should add; MRI’s were taken in the last 5 years for sinusitis infections, and it was then that I learned of the encephalomalcia. ) I still have not received the award letter, but learned it was generated on 24 Jan. In the meantime I have tried to learn all I can about TBi, medical care for tbi, and any other bit of information I can find. Mind you, in all these years, I have never been received treatment or an actual mental examination for my TBI. Upon reading the information you have provide armed with my 40% rating I am gong to request a full examination. I suspect, that I may in fact be due addition compensation for neck injuries and other mental issues that I have had over the years. To include quick to anger, a history of drinking after the accident, when I never drank before, and inappropriate behavior that over the years cause embarrassment to my family. When I finally see the examiner, is there anything in your mind that I need to mention that may help me in any way. Thank you for your service to veterans.

Follow up to my remarks above. I received the written award letter today… first let me say that getting this award was very easy. I do not agree with the rating because the examiner contradicted herself. For those of you who do not know, the examiner asked me questions and I gave verbal answers, she then scored the answers with a 1, 2, 3 or 4. a four is a 100% rating, a 3 = 70%, 2= 40, 1 – 0%…. she indicated a 0 for social activity yet indicated a 2 for neurobehavioral effects.. basically she indicated I get along well with people, but then said I am aggressive,lack empathy, self centered. She did not discuss any of the residual physical injuries such a neck injury, and she did not address my sleep issues, headaches etc… I have already completed my NOD. First not to be cocky, but if all a veteran has to do is answer questions about how they feel I don’t see how anyone could get less than 40%, and if the examiner is scoring the veteran only on what the veteran states, a 70% rating is very easy. Basically, all I had to do was have an MRI that showed brain damage, and produce about 9 pages of medical records from 1974, and answer a few questions over a 45 minute period. I have not received any treatment since 1974, but will now get treatment based on the award.

I was diagnosed with mild TBI by my VA Neurologist who was treating me for a condition called “Essential Tremor” It was the opinion of my Neurologist that the cause of my essential tremor was most likely the result of the mild TBI from an IED blast. In his exact words, my MRI brain scan looked like that pf an 80 year old dementia patient. In fact, I’m his youngest patient at the VA hospital in Houston. Naturally i filed for disability for both TBI and essential tremor and TBI…. Both were recently denied because in their words, couldn’t be proven service related. I’ve never had any head trauma prior to my Iraq deployment or tremor issues. I’m currently 60% combined rated for PTSD, Left shoulder injury, and tinnitus. I feel I’m being screwed here!

@Christopher Kruppa: Appeal the decision, it is their standard way of doing things. I also have a tbi, non combat veteran. I had a private doctor send me to a specialist in treating tbi’s, who have been treating me for over a year now. They will also back up their diagnosis in a court of law. Do not stop applying, do the appeal. And if neccissary go in front of the vba. Whatever you do, do not give up. There is a lot of good info both on this site for free, and also check out “hadit.com” The va sucks, they use any excuse not to give you a service connection for tbi’s. They are notorious for using unqualified shrinks to deny your claim. Don’t let them win. You deserve all you can get. Any questions. find the newest topic at the homepage. and post on that page. It is where most of us are at. Vets there can also chime in on what your going through, YOUR NOT ALONE.

Thank you for the information that you are providing here. I am currently assisting my brother who suffers from PTSD and TBI, among other issues, get service connection for his disabilities. This information has been extremely helpful for what we have been dealing with currently.